Paraphilia (cont.)

Roxanne Dryden-Edwards, MD

Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

What is the treatment for paraphilia?

The focus of research on the treatment for paraphilias is primarily focused on pedophilia, due to the terrible impact of this behavior on victims and due to the involvement of pedophilic offenders with the justice system. Those studies have shown that treatment only tends to work if the person with pedophilia is motivated and committed to controlling his or her behavior and when treatment combines psychotherapy and medication.

Psychotherapy for pedophilia and other paraphilias tends to use cognitive behavioral therapy. The focus of psychotherapy tends to be helping the person with pedophilia recognize and combat rationalizations about his or her behavior, as well as training the pedophilia sufferer in developing empathy for the victim and in techniques to control their sexual impulses. This therapy tends to take an approach to treating sexual offenders using a relapse prevention model that is similar to treating people with a drug addiction. This approach tries to help the paraphilic person anticipate situations that increase their risk of sexually acting out and finding ways to avoid or more productively respond to those triggers. People with paraphilia may also benefit from social skills training to help them develop age-appropriate, reciprocal relationships.

Medications that suppress production of the male hormone testosterone can be used to reduce the frequency or intensity of sexual desire in pedophiles. It may take three to 10 months for testosterone suppression to reduce sexual desire. Studies of the effectiveness of selective serotonin reuptake inhibitors (SSRIs) in treating pedophilia and other paraphilias vary in their findings on their effectiveness. However, SSRIs may be a helpful addition to other treatments, because they tend to decrease sexual obsessiveness and urges associated with paraphilias and may also help with increasing the paraphile’s ability to control his or her impulses. Examples of SSRI medications include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro).

There is some preliminary research that stimulant medications like methylphenidate (Ritalin) can increase the effectiveness of SSRIs, and naltrexone can decrease some of the sexual obsessiveness associated with paraphilias.

What is the prognosis of paraphilia?

Paraphilias have been found to be quite chronic such that a minimum of two years of treatment is recommended for even the mildest paraphilia. While most people with a paraphilia do not sexually offend, and sexual offending is not considered a mental illness, people who commit sexual offenses sometimes also have a paraphilia.

Is it possible to prevent paraphilias?

Given that paraphilic behavior tends to be highly stigmatized and some paraphilic behaviors are illegal, tracking how successful treatment often involves rates of criminal recidivism. Therefore, prevention of future paraphilic behavior often focuses on preventing sexual offenders from having access to potential victims. Prevention for the development of any paraphilic behavior usually involves alleviating the psychosocial risk factors for its development.